Nurse Practitioner Review Question of the DayANCC / AANP Exam Review Question of the Day, Courtesy of Med-Challenger
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A 74-year-old woman presents to you for a follow-up visit after abnormal liver chemistries on routine blood testing. She has a history of osteoarthritis for which she takes acetaminophen 1 to 2 g daily and has for several years. She also has longstanding hyperlipidemia for which she takes simvastatin 20 mg nightly at bedtime. The patient was started on amoxicillin/clavulanate recently for sinusitis and is on day 10 of a 14-day course. She has no symptoms at this time.
On physical examination, she has no spider angiomas or other stigmata of chronic liver disease.
Her laboratory values reveal the following:
White blood cell count: 5500/µL
Hemoglobin: 13.2 g/dL
Albumin: 3.7 g/dL
Aspartate aminotransferase: 42 U/L
Alanine aminotransferase: 55 U/L
Alkaline phosphatase: 245 U/L
Total bilirubin: 2.5 mg/dL
International normalized ratio: 1.2
Serologies for hepatitis A, B, and C viruses, as well as antimitochondrial antibody and celiac serologies, are unremarkable. Previous liver chemistries during the past 5 years have not demonstrated any abnormalities.
Right-upper quadrant ultrasonography demonstrates normal biliary and pancreatic ducts as well as a liver with mild fatty infiltration.
She denies any recent use of herbal medications, and the only recent change in her medications was a course of amoxicillin/clavulanate, which she says she started 2 weeks ago for chronic sinusitis.
Which of the following is the most likely to improve her liver chemistry abnormalities?
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